Provider Demographics
NPI:1518075761
Name:SWAIN, ALBERT H (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:H
Last Name:SWAIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 ARLINGTON LANE NORTH
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731
Mailing Address - Country:US
Mailing Address - Phone:609-693-5084
Mailing Address - Fax:
Practice Address - Street 1:20 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 20
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-349-8416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ78701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1203100Medicaid